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Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Where on your body is the tattoo?*
What colours are in your tattoo?*
What is the approximate age of the tattoo?*
What is your desired outcome?*
Have you had any previous treatments on your tattoo? If so, how many sessions and at which clinic?*
Which of the following best describes your skin type?*

Always burns / never tansUsually burns / tans with difficultySometimes mild burn / gradually tansRarely burns / tans with easeVery rarely burns / tans very easilyNever burns / tans very easily
Are you on any medication? if so, please advise what medication below:*
What are the rough dimensions of your tattoo in cm? e.g. 5cmx5cm*
Anything else you would like to tell us?
Please provide a photo of the tattoo you're looking to have removed:*

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Let's work together